<p>Please fill out the following details to create your Flatshare account.</p>
<p>(Required fields are marked with a *)</p>
<form name="registrationForm" id="registrationForm" method="post" action="?subscribe=y" onSubmit="javascript:return checkform();">
	<table>
    	<tr>
        	<td><label for="username">Username:</label></td>
            <td>*</td>
            <td><input type="text" name="username" id="username" maxlength="20" size="20" /></td>
        </tr>
        <tr>
       		<td><label for="password1">Password: </label></td>
            <td>*</td>
            <td><input type="password" name="password1" id="password1" size="15" /></td>
        </tr>
        <tr>
       		<td><label for="password2">Confirm Password: </label></td>
            <td>*</td>
            <td><input type="password" name="password2" id="password2" size="15" /></td>
        </tr>
        <tr>
        	<td><label for="fname">First Name:</label></td>
            <td>*</td>
            <td><input type="text" name="fname" id="fname" maxlength="20" size="20" /></td>
        </tr>
        <tr>
        	<td><label for="lname">Last Name:</label></td>
            <td>*</td>
            <td><input type="text" name="lname" id="lname" maxlength="20" size="20" /></td>
        </tr>
        <tr>
        	<td><label for="dob">Date of Birth:</label></td>
            <td>*</td>
            <td><input type="text" name="dob" id="dob" maxlength="20" size="20" /> (DD/MM/YYYY)</td>
        </tr>
        <tr>
        	<td><label for="title">Title:</label></td>
            <td></td>
            <td><input type="text" name="title" id="title" maxlength="5" size="5" /></td>
        </tr>
        <tr>
        	<td><label for="email">Email Address:</label></td>
            <td>*</td>
            <td><input type="text" name="email" id="email" maxlength="40" size="40" /></td>
        </tr>
        <tr>
        	<td><label for="mobno">Mobile Number:</label></td>
            <td></td>
            <td><input type="text" name="mobno" id="mobno" maxlength="10" size="10" /></td>
        </tr>
        <tr>
        	<td><label for="homeno">Home Number:</label></td>
            <td></td>
            <td><input type="text" name="homeno" id="homeno" maxlength="10" size="10" /></td>
        </tr>
        <tr>
        	<td><label for="workno">Work Number:</label></td>
            <td></td>
            <td><input type="text" name="workno" id="workno" maxlength="10" size="10" /></td>
        </tr>
    </table>
    <input type="submit" value="Submit"> 
</form>